The impact of malocclusions on oral health-related quality of life in children—a systematic review and meta-analysis

Clinical Oral Investigations, Dec 2015

Introduction A limited amount of systematic literature reviews on the association between malocclusions and oral health-related quality of life (OHRQOL) summarize inconclusive results. Therefore, we conduct a systematic review and meta-analysis on the association of malocclusions with OHRQOL in children. Methods Relevant studies were identified in Pubmed, Embase, Cochrane, Google Scholar and other databases. All studies with data on malocclusions or orthodontic treatment need and OHRQOL in children were included. Methodological quality of the studies was assessed with the Newcastle-Ottawa Scale (NOS). Random effects models were used to estimate summary effect measures for the association between malocclusion and OHRQOL in a continuous and a categorical data analysis. Tests for heterogeneity, publication bias and sensitivity of results were performed. Results In total, 40 cross-sectional studies were included in the meta-analyses. Summary measures of the continuous data show that OHRQOL was significantly lowered in children with malocclusions (standardized mean difference (95 % CI] = 0.29 (0.19–0.38)). The summary odds ratio for having an impact on OHRQOL was 1.74 times higher in children with malocclusion than in children without malocclusions. Heterogeneity among studies was partly explained by malocclusion assessment, age of the children and country of study conduction. Conclusion Our results provide evidence for a clear inverse association of malocclusion with OHRQOL. We also showed that the strength of the association differed depending on the age of the children and their cultural environment. Clinical relevance Dentists benefit from understanding the patient differences regarding the impact of malocclusions.

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The impact of malocclusions on oral health-related quality of life in children—a systematic review and meta-analysis

P.O Box The impact of malocclusions on oral health-related quality of life in children-a systematic review and meta-analysis Lea Kragt 0 1 2 4 5 Brunilda Dhamo 0 1 2 4 5 Eppo B. Wolvius 0 1 2 4 5 Edwin M. Ongkosuwito 0 1 2 4 5 0 Edwin M. Ongkosuwito 1 Eppo B. Wolvius 2 Brunilda Dhamo 3 , Erasmus Medical Center , Rotterdam , The Netherlands 4 Department of The Generation R Study Group, Erasmus University Medical Center , Rotterdam , The Netherlands 5 Department of Oral & Maxillofacial Surgery , Special Dental Care and Orthodontics Introduction A limited amount of systematic literature reviews on the association between malocclusions and oral health-related quality of life (OHRQOL) summarize inconclusive results. Therefore, we conduct a systematic review and meta-analysis on the association of malocclusions with OHRQOL in children. Methods Relevant studies were identified in Pubmed, Embase, Cochrane, Google Scholar and other databases. All studies with data on malocclusions or orthodontic treatment need and OHRQOL in children were included. Methodological quality of the studies was assessed with the NewcastleOttawa Scale (NOS). Random effects models were used to estimate summary effect measures for the association between malocclusion and OHRQOL in a continuous and a categorical data analysis. Tests for heterogeneity, publication bias and sensitivity of results were performed. Results In total, 40 cross-sectional studies were included in the meta-analyses. Summary measures of the continuous data show that OHRQOL was significantly lowered in children with malocclusions (standardized mean difference (95 % CI] =0.29 (0.19-0.38)). The summary odds ratio for having an impact on OHRQOL was 1.74 times higher in children with malocclusion than in children without malocclusions. Heterogeneity among studies was partly explained by malocclusion assessment, age of the children and country of study conduction. Conclusion Our results provide evidence for a clear inverse association of malocclusion with OHRQOL. We also showed that the strength of the association differed depending on the age of the children and their cultural environment. Clinical relevance Dentists benefit from understanding the patient differences regarding the impact of malocclusions. Meta- analysis; Quality of life; Malocclusions; Children Introduction Malocclusion is one of the most common oral disorders in the Netherlands. In 2005, half of the Dutch adolescents have had orthodontic treatment, and in 2011, this proportion increased to 60 % [ 1 ]. A variety of deviant occlusal traits exist that in itself can vary in severity. The concept of oral health-related quality of life (OHRQOL) arose in the orthodontic literature to explain the variability in professionally determined (objectively) and patient-determined (subjectively) need for orthodontic treatment [ 2, 3 ]. OHRQOL is a patient-reported outcome assessed by questionnaires to measure the psychological impact of the dentition. More precisely, OHRQOL is the interplay of oral health variables such as biological and physiological functional status, as well as personal attributes like role functioning, social functioning and psychological functioning, that represent the multidimensional and individual perception of oral health [4]. In this way, it describes the standard of the oral and related tissues which enables an individual to eat, speak and socialize without active disease, discomfort or embarrassment and which contributes to general well-being [ 5 ]. In the last 15 years, the literature on the association of malocclusions and OHRQOL has greatly expanded [ 6 ]. Most studies in the orthodontic literature on OHRQOL use small convenience samples, which limits their evidence. In 2006, Zhang et al emphasized the impact of heterogeneous population groups and measurement tools on the conflicting evidence in orthodontic OHRQOL research [ 3 ]. Indeed, Liu et al reviewed the literature in 2009, but found only a modest association between malocclusion and the quality of life among mixed ages [ 2 ]. A recent meta-analysis on malocclusions, orthodontic treatment and OHRQOL in adults found a moderate increase of OHRQOL after treatment (standardized mean difference (SMD)(95 % CI) 1.29 (0.67–1.92)), but the difference in OHRQOL between people with and people without malocclusion was small (SMD (95 % CI) 0.84 (0.25– 1.43)) [ 7 ]. Both reviews suffered from the considerable differences in study design. The impact of malocclusions and OHRQOL might be different in children than in adults as they deal differently with disease, but also with psychological, social and emotional factors [ 8 ]. In addition, children and adult OHRQOL measures are different; thus, they should not be investigated simultaneously. When the focus lies on OHRQOL in children, a variety of instruments exist without one universally accepted. One of the first instruments used in adolescents is the Oral Health Impact Profi (...truncated)


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Lea Kragt, Brunilda Dhamo, Eppo B. Wolvius, Edwin M. Ongkosuwito. The impact of malocclusions on oral health-related quality of life in children—a systematic review and meta-analysis, Clinical Oral Investigations, 2016, pp. 1881-1894, Volume 20, Issue 8, DOI: 10.1007/s00784-015-1681-3